OIC Investigation Procedures & Methods 3 — Questions and Answers
Question 1: Which Oregon statute primarily governs the reporting of suspected insurance fraud by insurers?
- ORS Chapter 742
- ORS Chapter 746 (Correct answer)
- ORS Chapter 731
- ORS Chapter 163
Correct answer: ORS Chapter 746
ORS Chapter 746 covers insurance trade practices and includes mandatory fraud reporting requirements for insurers in Oregon.
Question 2: When an Oregon inspector identifies a pattern of claims from the same medical provider, the MOST appropriate investigative technique is:
- Immediately revoke the provider's license
- Conduct a link analysis to map relationships between claimants and the provider (Correct answer)
- Interview only the most recent claimant
- Close all associated claims as fraudulent
Correct answer: Conduct a link analysis to map relationships between claimants and the provider
Link analysis maps relationships between claimants, providers, and incidents to detect organized fraud schemes.
Question 3: An investigator is preparing to interview a witness in an Oregon insurance claim. Which approach is MOST effective for obtaining accurate information?
- Begin with leading questions to confirm the investigator's theory
- Use open-ended questions to allow the witness to narrate events freely (Correct answer)
- Only ask yes-or-no questions to keep the interview brief
- Record the witness without their knowledge
Correct answer: Use open-ended questions to allow the witness to narrate events freely
Open-ended questions allow witnesses to provide narrative accounts, reducing interviewer bias and capturing details the investigator may not have anticipated.
Question 4: In Oregon, the 'two-year look-back' in insurance investigations typically refers to:
- The statute of limitations for filing a civil fraud lawsuit
- Reviewing prior claim history within two years to identify patterns (Correct answer)
- The mandatory retention period for claim files
- The period within which a policy can be rescinded for misrepresentation
Correct answer: Reviewing prior claim history within two years to identify patterns
Reviewing prior claims within a two-year window helps investigators identify patterns of repeated or staged losses.
Question 5: When gathering digital evidence during an Oregon insurance investigation, chain of custody is critical because it:
- Speeds up the claims settlement process
- Ensures the evidence is admissible and has not been tampered with (Correct answer)
- Allows the investigator to share evidence publicly
- Satisfies the claimant's right to privacy
Correct answer: Ensures the evidence is admissible and has not been tampered with
An unbroken chain of custody demonstrates that digital evidence has not been altered, making it admissible in legal proceedings.
Question 6: Which of the following is a RED FLAG indicator of a staged vehicle accident claim in Oregon?
- Accident occurred on a major interstate during rush hour
- Claimant reported the accident to police within 24 hours
- Multiple claimants all share the same attorney and treatment facility (Correct answer)
- Vehicle damage is consistent with the described impact
Correct answer: Multiple claimants all share the same attorney and treatment facility
Multiple claimants using the same attorney and treatment facility after a single accident is a classic indicator of a staged collision ring.
Question 7: An Oregon insurance investigator's field notes should ALWAYS include:
- Personal opinions about the claimant's honesty
- Date, time, location, and objective observations only (Correct answer)
- Speculation about possible motives
- Summaries of the claimant's past criminal history
Correct answer: Date, time, location, and objective observations only
Field notes must be objective and factual, recording only what was directly observed with specific date, time, and location references.
OIC Investigation Procedures & Methods 3
Which Oregon statute primarily governs the reporting of suspected insurance fraud by insurers?